Flammia Rocco Simone, Anceschi Umberto, Tufano Antonio, Tuderti Gabriele, Ferriero Maria Consiglia, Brassetti Aldo, Mari Andrea, Di Maida Fabrizio, Minervini Andrea, Derweesh Ithaar H, Capitanio Umberto, Larcher Alessandro, Montorsi Francesco, Eun Daniel D, Lee Jennifer, Luciani Lorenzo G, Cai Tommaso, Malossini Gianni, Veccia Alessandro, Autorino Riccardo, Fiori Cristian, Porpiglia Francesco, Gallucci Michele, Leonardo Costantino, Simone Giuseppe
Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy.
Department of Urologic Oncology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy.
J Clin Med. 2022 Feb 25;11(5):1243. doi: 10.3390/jcm11051243.
Hypertension (HTN) is a global public health issue. There are limited data regarding the effects of HTN in patients undergoing partial nephrectomy (PN) for renal tumors. To address this void, we tested the association between HTN and renal function after minimally invasive PN (MIPN).
Using a multi-institutional database (2007-2017), we identified patients aged ≥ 18 years with a diagnosis of cT1 renal tumors treated with MIPN. Kaplan-Meier plots and Cox regression models addressed newly-onset CKD stage ≥ 3b or higher (sCKD). All analyses were repeated after 1:1 propensity score matching (PSM).
Overall, 2144 patients were identified. Of those, 35% ( = 759) were yes-HTN. Yes-HTN patients were older, more frequently male and more often presented with diabetes. Yes-HTN patients harbored higher RENAL nephrometry scores and higher cT stages than no-HTN patients. Conversely, yes-HTN patients exhibited lower preoperative eGFRs. In the overall cohort, five-year sCKD-free survival was 86% vs. 94% for yes-HTN vs. no-HTN, which translated into a multivariable HR of 1.67 (95% CI: 1.06-2.63, = 0.026). After 1:1 PSM, virtually the same results were observed (HR 1.86, 95% CI: 1.07-3.23, = 0.027).
Yes-HTN patients exhibited worse renal function after MIPN when compared to their no-HTN counterparts. However, these observations need to be further tested in a prospective cohort study.
高血压（HTN）是一个全球性的公共卫生问题。关于高血压对接受肾肿瘤部分肾切除术（PN）患者的影响的数据有限。为填补这一空白，我们测试了微创部分肾切除术（MIPN）后高血压与肾功能之间的关联。
利用一个多机构数据库（2007 - 2017年），我们确定了年龄≥18岁、诊断为cT1肾肿瘤并接受MIPN治疗的患者。Kaplan - Meier曲线和Cox回归模型用于分析新发慢性肾脏病（CKD）≥3b期或更高分期（sCKD）的情况。所有分析在1:1倾向评分匹配（PSM）后重复进行。
总体上，共确定了2144例患者。其中，35%（n = 759）为高血压患者。高血压患者年龄更大，男性比例更高，且更常伴有糖尿病。与非高血压患者相比，高血压患者的RENAL肾计量评分更高，cT分期更高。相反，高血压患者术前估算肾小球滤过率（eGFR）更低。在整个队列中，高血压患者与非高血压患者的五年无sCKD生存率分别为86%和94%，这转化为多变量风险比（HR）为1.67（95%置信区间：1.06 - 2.63，P = 0.026）。在1:1 PSM后，观察到几乎相同的结果（HR 1.86，95%置信区间：1.07 - 3.23，P = 0.027）。
与非高血压患者相比，高血压患者在MIPN后肾功能更差。然而，这些观察结果需要在前瞻性队列研究中进一步验证。
